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NPI Code Detail

MEDICARE: BETHANY CARNEVALE DPT

MEDICARE: BETHANY CARNEVALE DPT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225100000XPhysical TherapistPT02641RI

General Provider Information

NPI Number : 1780011056
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETHANY CARNEVALE DPT
Provider Business Mailing Address
First Line : 4 RICHMOND SQ STE 200
Second Line :
City : PROVIDENCE
State : RI
Zip : 02906-5117
Country : US
Telephone Number : 401-433-4172
Fax Number : 401-433-0612
Provider Business Practice Location Address
First Line : 1401 DOUGLAS AVE
Second Line :
City : NORTH PROVIDENCE
State : RI
Zip : 02904-4058
Country : US
Telephone Number : 401-435-4540
Fax Number : 401-434-4521
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2013
Last Update Date : 12/12/2017

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Directions to “ BETHANY CARNEVALE DPT” Practice Location

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